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Testing a Peer Support Program for Parents of Infants Going Home from the NICU
Get PDFU.S. newborns requiring care in a neonatal intensive care unit (NICU) have an increased risk of long-term disability, and short-term or ongoing specialty care.
Parents of these infants report increased anxiety and stress in the NICU and after discharge.https://knowledgeconnection.mainehealth.org/reach/1020/thumbnail.jp
Delirium Protocols and the Impact on Patient\u27s Extended Stays and Care
Get PDFPICOT Question: In patients with stays over 3 days, how does a delirium protocol and interventions improve their stay and symptoms compared to the current standard of practices to shorten length of stay and improvement in care quality within a 6-month experience?https://knowledgeconnection.mainehealth.org/nurseresidency/1045/thumbnail.jp
Interventions to Improve Mental Health in New Graduate Nurses
Get PDFPICOT Question: In new graduate nurses (CN1), how does mental health support groups compared to no specific mental health support affect new nurses within the first year of hire?https://knowledgeconnection.mainehealth.org/nurseresidency/1053/thumbnail.jp
Results of a Needs Assessment: Use of Sexual Orientation and Gender Identity Data in Health Systems in Maine
Get PDFIntroduction: Lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) patients experience significantly more health care disparities than non-LGBTQ+ patients. Although sexual orientation and gender identity data (SOGI) would help quantify and track these known disparities, there are no standardized methods for routinely and consistently including SOGI into health care management in Maine. Our needs assessment (1) evaluates the comfort of health care professionals (HCPs) in collecting SOGI and incorporating it into the medical record and (2) identifies barriers to SOGI collection.
Methods: An interprofessional team conducted a survey of Maine HCPs who identified as working directly with patients or patient records and information to assess how they manage LGBTQ+ data. We then conducted focus groups with survey participants, coded the transcripts, and identified recurrent themes through thematic analysis.
Results: We found that of 357 interprofessional respondents, 62.9% of HCPs agreed that SOGI should be collected with every patient. However, only 30.1% reported collecting SOGI for “all or most” of their patients. The primary barriers to data collection and use were identified as lack of education and comfort with LGBTQ+ topics, HCP concern for causing patient discomfort, and lack of standardization of data management and workflow.
Discussion: Most HCPs in Maine are not yet comfortable with routinely incorporating SOGI. Even if they were comfortable, patient workflows and electronic health records vary widely across systems, and this inconsistency is a substantial obstacle to standardizing SOGI collection. A multidimensional approach is needed to address these barriers moving forward.
Conclusions: HCP’s discomfort with LGBTQ+ topics and non-standardized workflows are driving factors that must be overcome to fully incorporate SOGI collection as a standard best practice
Communication Strategies for Transferring Medically Complex Children Out of Intensive Care
No full textCharacteristics and outcomes of a hospitalized cohort with reduced mortality from COVID-19, White Mountain apache tribal lands, April 1 - July 31, 2020
No full textBACKGROUND: Widespread transmission of COVID-19 continues to threaten public health, particularly of rural, American Indian communities. Although COVID-19 risk factors for severe disease and clinical characteristics are well described in the general population, there has been little shared on hospitalized American Indian populations. METHODS: In this observational study, we performed chart extractions on all persons hospitalized with COVID-19 from April 1 through July 31, 2020 among an exclusively American Indian population living on or near Tribal lands in eastern Arizona. We provide descriptive statistics for the cohort stratified by presentation, comparing those who self-presented or were referred by an outreach program. Exploratory analyses were performed to identify risk factors for morbidity and mortality. RESULTS: During the observation period, 2262 persons were diagnosed with COVID-19 and 490 (22%) were hospitalized. Hospitalized persons had a median age of 54 years; 92% had at least one comorbidity, 72% had greater than one comorbidity, and 60% had a BMI of \u3e 30. Most persons required supplemental oxygen (83%), but the majority (62%) only required nasal cannula and only 11% were intubated. The case fatality rates were 1.7% for the population, 7.1% among hospitalizations, and 9.3% among hospitalized patients 50 years and older. All rates that are significantly lower than those reported nationally during the same period. CONCLUSIONS: We observed a cohort of American Indian patients hospitalized secondary to COVID-19 with greater number of comorbidities compared to the general population but with lower mortality rates. We posit that the primary driver of mortality reduction for this population and the hospitalized cohort was a community-based referral program that led to disproportionately lower fatality rates among the oldest persons
Laser assisted trans-endograft coil embolization of a type II endoleak
No full textA type II endoleak after endovascular aneurysm repair can be challenging to stop. Numerous methods have been described, including trans-arterial, trans-lumbar, trans-caval, trans-endograft, peri-endograft, and open and laparoscopic surgical techniques. We present our experience with a laser-assisted trans-endograft approach, including technical variations of previous descriptions that might improve efficacy. In select cases, the laser-assisted trans-endograft approach might provide the most direct method of accessing and occluding the vessels feeding type II endoleaks
Cemiplimab for Kidney Transplant Recipients With Advanced Cutaneous Squamous Cell Carcinoma
No full textPURPOSE: Cemiplimab is approved for treating locally advanced or metastatic cutaneous squamous cell carcinoma (CSCC). Solid organ transplant recipients have been excluded from immunotherapy trials, given concern for allograft rejection despite their increased risk of skin cancers. Chronic immunosuppression is necessary to prevent organ rejection but may attenuate antitumor response with PD-1 inhibitors. METHODS: We report a phase I study of cemiplimab for kidney transplant recipients (KTRs) with advanced CSCC. After cross-taper to a mammalian target of rapamycin (mTOR) inhibitor and pulsed dose corticosteroids (prednisone 40 mg once daily, the day before and on days 1-3 of each cycle, followed by 20 mg once daily on days 4-6, then 10 mg once daily until the day before each subsequent cycle), patients received cemiplimab 350 mg intravenously once every 3 weeks for up to 2 years and were assessed for response every 8 weeks. The primary end point was the rate of kidney rejection, with key secondary end points including rate and duration of response, and survival. RESULTS: Twelve patients were treated. No kidney rejection or loss was observed. A response to cemiplimab was observed in five of 11 evaluable patients (46%; 90% CI, 22 to 73), including two with durable responses beyond a year. Median follow-up was 6.8 months (range, 0.7-29.8). Treatment-related grade 3 or greater adverse events occurred in five patients (42%), including diarrhea, infection, and metabolic disturbances. One patient died of angioedema and anaphylaxis attributed to mTOR inhibitor cross-taper. CONCLUSION: mTOR inhibitor and corticosteroids represent a favorable immunosuppressive regimen for KTRs with advanced CSCC receiving immunotherapy. This combination resulted in durable antitumor responses with no kidney rejection events (funded by Regeneron Pharmaceuticals [ClinicalTrials.gov identifier: NCT04339062])
Autoinflammatory Disease: Attack of the Inflammasome
No full textPresented by: Edward Fels, MD, Adult & Pediatric Rheumatology, Rheumatology Associates
DATE OF PRESENTATION: March 7th, 2024
CME available for 1 year after presentation
Please complete an evaluation in CloudCME to claim credit for this presentation.https://knowledgeconnection.mainehealth.org/pediatrics_gr/1040/thumbnail.jp
Real-world effectiveness of elexacaftor/tezacaftor/ivacaftor on the burden of illness in adolescents and adults with cystic fibrosis
No full textBACKGROUND: Elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) has been shown to be safe and efficacious in people with cystic fibrosis (CF) aged ≥2 years. Here, we describe results from an observational study assessing change in burden of illness following initiating ELX/TEZ/IVA in real-world settings. METHODS: This US-based, multicenter, observational study used data from electronic medical records to evaluate real-world burden of illness before and after ELX/TEZ/IVA initiation in people with CF aged ≥12 years heterozygous for and a minimal function mutation (/MF) or an uncharacterized mutation. Endpoints included absolute change from baseline in percent predicted forced expiratory volume in 1 s (ppFEV), body mass index (BMI) and BMI-for-age z-score, glycated hemoglobin (HbA1c), and numbers of pulmonary exacerbations (PEx). RESULTS: Overall, 206 people with CF were enrolled (mean [SD] age 22.5 [11.1] years; 192 [93.2%] with /MF genotype). Mean follow-up was 15.6 (SD, 1.6) months. Improvements in ppFEV (7.3 [95% CI: 5.7, 8.8] percentage points) were observed from baseline through follow-up. Increases in BMI (1.40 [95% CI: 1.07, 1.77] kg/m) and BMI-for-age z-score (0.14 [95% CI: 0.00, 0.28]) were also observed from baseline at 12 months. The estimated annualized rate of any PEx was 1.31 at baseline and 0.61 over follow-up (rate ratio 0.47 [95% CI: 0.39, 0.55]), with annualized rates of PEx requiring antibiotics and hospitalizations of 0.55 and 0.88 in the baseline period and 0.12 and 0.36 over follow-up (rate ratios 0.22 [95% CI: 0.15, 0.31] and 0.41 [95% CI: 0.32, 0.51]), respectively. Absolute change in HbA1c was -0.22 (95% CI: -0.38, -0.06) from baseline through follow-up. CONCLUSIONS: ELX/TEZ/IVA treatment was associated with improved lung function, increased BMI, reduced frequency of PEx, and improved (i.e., reduced) HbA1c. These results confirm the broad clinical benefits of ELX/TEZ/IVA seen in clinical trials and show the potential for ELX/TEZ/IVA to improve markers of glucose metabolism